Thursday, August 31, 2006

Typhoid

What is typhoid fever?Typhoid fever is an infection of the intestines which spreads to the blood and other parts of the body. It is caused by the bacteria, Salmonella typhi. In 2001, there were 48 cases reported among New York City residents (rate of 0.7 cases per 100,000 persons).

Who gets the disease?Anyone can get typhoid fever, but the greatest risk is to travelers visiting countries where the disease is common. Occasionally, local cases can be traced to exposure to a person who is a chronic carrier.

How is the typhoid fever germ spread?Typhoid germs are passed in the stool (feces) and, to some extent, the urine of infected people. The germs are spread by eating or drinking water or foods contaminated by stool (feces) from an infected person.

What are the symptoms of typhoid fever?Symptoms may be mild or severe and may include fever, headache, constipation or diarrhea, rose-colored spots on the trunk, and an enlarged spleen and liver. Relapses are common. Fatalities are less than 1% with antibiotic treatment.

How soon after infection do symptoms appear?Symptoms generally appear one to three weeks after exposure.

For how long can an infected person carry the germ?The carrier stage varies from a number of days to years. Only about 3% of cases go on to become lifelong carriers of the germ, and this tends to occur more often in adults than children.

How is typhoid fever diagnosed?Typhoid fever is diagnosed by isolating the bacteria from a patient's stool or blood.

How is typhoid fever treated?Specific antibiotics such as ampicillin or ciprofloxacin are often used to treat typhoid fever.

Should an infected person be isolated or excluded from work or school?Since the typhoid bacteria are in the stool (feces), only people with active diarrhea who are unable to control their bowel habits (e.g., infants, young children, certain handicapped individuals) should be isolated. Most infected people may return to work or school when their stools become formed as long as they carefully wash their hands after using the toilet. Food handlers, health care workers, and children in day care must obtain the approval of the Health Department before returning to their routine activities. This requires follow-up stool testing to be sure that they are no longer infectious. Since infected persons may shed the bacteria for months to years, the Health Department requires repeat stool testing for at least 3 months for all patients with typhoid.

How can typhoid fever be prevented?A vaccine is available but is generally reserved for people traveling to internationally to countries where significant exposure may occur. Strict attention to food and water precautions while traveling to such countries is the most effective preventive method.

People traveling to countries where typhoid is endemic should exercise the following precautions:

• Avoid drinking tap water unless it has been boiled. • Only eat foods that have been thoroughly cooked. Fruits and vegetables can be eaten if you have peeled them yourself. • Avoid eating fruits and vegetables that have not been cooked or pealed such as salads. • Avoid undercooked or raw fish or shellfish. • Avoid eating foods or beverages from street vendors or food service establishments where the sanitary conditions appear poor.

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